Healthcare Provider Details

I. General information

NPI: 1962691915
Provider Name (Legal Business Name): KATHRYN LINETTE COBB MA LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 N ACCESS RD
CLYDE TX
79510-3352
US

IV. Provider business mailing address

1712 N ACCESS RD
CLYDE TX
79510-3352
US

V. Phone/Fax

Practice location:
  • Phone: 325-893-4010
  • Fax: 325-893-4042
Mailing address:
  • Phone: 325-893-4010
  • Fax: 325-893-4042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number57645
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number57645
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: